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Esophagogastroduodenoscopy (EGD) or oesophagogastroduodenoscopy (OGD), also called by various other names, is a
diagnostic Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine "cause and effect". In systems enginee ...
endoscopic An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are inse ...
procedure that visualizes the upper part of the gastrointestinal tract down to the duodenum. It is considered a minimally invasive procedure since it does not require an
incision Incision may refer to: * Cutting, the separation of an object, into two or more portions, through the application of an acutely directed force * A type of open wound caused by a clean, sharp-edged object such as a knife, razor, or glass splinter * ...
into one of the major body cavities and does not require any significant recovery after the procedure (unless sedation or
anesthesia Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain), paralysis (muscle relaxation), ...
has been used). However, a
sore throat Sore throat, also known as throat pain, is pain or irritation of the throat. Usually, causes of sore throat include * viral infections * group A streptococcal infection (GAS) bacterial infection * pharyngitis (inflammation of the throat) * to ...
is common.


Alternative names

The words ''esophagogastroduodenoscopy'' (EGD;
American English American English, sometimes called United States English or U.S. English, is the set of varieties of the English language native to the United States. English is the most widely spoken language in the United States and in most circumstances ...
) and ''oesophagogastroduodenoscopy'' (OGD;
British English British English (BrE, en-GB, or BE) is, according to Oxford Dictionaries, "English as used in Great Britain, as distinct from that used elsewhere". More narrowly, it can refer specifically to the English language in England, or, more broadl ...
; see spelling differences) are both pronounced . It is also called ''panendoscopy'' (PES) and ''upper GI endoscopy''. It is also often called just ''upper endoscopy'', ''upper GI'', or even just ''endoscopy''; because EGD is the most commonly performed type of endoscopy, the ambiguous term ''endoscopy'' is sometimes informally used to refer to EGD by default. The term ''gastroscopy'' literally focuses on the stomach alone, but in practice, the usage overlaps.


Medical uses


Diagnostic

* Unexplained
anemia Anemia or anaemia (British English) is a blood disorder in which the blood has a reduced ability to carry oxygen due to a lower than normal number of red blood cells, or a reduction in the amount of hemoglobin. When anemia comes on slowly, t ...
(usually along with a colonoscopy) *
Upper gastrointestinal bleeding Upper gastrointestinal bleeding is gastrointestinal bleeding in the upper gastrointestinal tract, commonly defined as bleeding arising from the esophagus, stomach, or duodenum. Blood may be observed in vomit or in altered form as black stool. ...
as evidenced by hematemesis or
melena Melena or melaena refers to the dark black, tarry feces that are associated with upper gastrointestinal bleeding. The black color and characteristic strong odor are caused by hemoglobin in the blood being altered by digestive enzymes and intest ...
* Persistent dyspepsia in patients over the age of 45 years * Heartburn and chronic acid reflux – this can lead to a precancerous lesion called
Barrett's esophagus Barrett's esophagus is a condition in which there is an abnormal ( metaplastic) change in the mucosal cells lining the lower portion of the esophagus, from stratified squamous epithelium to simple columnar epithelium with interspersed goblet cells ...
* Persistent emesis *
Dysphagia Dysphagia is difficulty in swallowing. Although classified under "symptoms and signs" in ICD-10, in some contexts it is classified as a condition in its own right. It may be a sensation that suggests difficulty in the passage of solids or liq ...
– difficulty in swallowing * Odynophagia – painful swallowing * Persistent
nausea Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of th ...
* IBD ( inflammatory bowel diseases)


Surveillance

* Surveillance of
Barrett's esophagus Barrett's esophagus is a condition in which there is an abnormal ( metaplastic) change in the mucosal cells lining the lower portion of the esophagus, from stratified squamous epithelium to simple columnar epithelium with interspersed goblet cells ...
* Surveillance of gastric ulcer or duodenal ulcer * Occasionally after gastric surgery


Confirmation of diagnosis/biopsy

* Abnormal barium swallow or barium meal * Confirmation of celiac disease (via biopsy)


Therapeutic

* Treatment (banding/sclerotherapy) of esophageal varices * Injection therapy (e.g., epinephrine in bleeding lesions) * Cutting off of larger pieces of tissue with a snare device (e.g., polyps, endoscopic mucosal resection) * Application of cautery to tissues * Removal of foreign bodies (e.g., food) that have been ingested * Tamponade of bleeding esophageal varices with a
balloon A balloon is a flexible bag that can be inflated with a gas, such as helium, hydrogen, nitrous oxide, oxygen, and air. For special tasks, balloons can be filled with smoke, liquid water, granular media (e.g. sand, flour or rice), or lig ...
* Application of photodynamic therapy for treatment of esophageal malignancies * Endoscopic drainage of pancreatic pseudocyst * Tightening the lower esophageal sphincter * Dilating or stenting of stenosis or achalasia *
Percutaneous endoscopic gastrostomy Percutaneous endoscopic gastrostomy (PEG) is an endoscopic medical procedure in which a tube (PEG tube) is passed into a patient's stomach through the abdominal wall, most commonly to provide a means of feeding when oral intake is not adequate ( ...
(feeding tube placement) * Endoscopic retrograde cholangiopancreatography (ERCP) combines EGD with fluoroscopy * Endoscopic ultrasound (EUS) combines EGD with 5–12 MHz
ultrasound Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies ...
imaging


Newer interventions

* Endoscopic trans-gastric laparoscopy * Placement of gastric balloons in bariatric surgery


Complications

The complication rate is about 1 in 1000. They include: * aspiration, causing aspiration pneumonia * bleeding * perforation * cardiopulmonary problems When used in
infant An infant or baby is the very young offspring of human beings. ''Infant'' (from the Latin word ''infans'', meaning 'unable to speak' or 'speechless') is a formal or specialised synonym for the common term ''baby''. The terms may also be used t ...
s, the esophagogastroduodenoscope may compress the
trachealis muscle The trachealis muscle is a sheet of smooth muscle in the trachea. Structure The trachealis muscle lies posterior to the trachea and anterior to the oesophagus. It bridges the gap between the free ends of C-shaped rings of cartilage at the poste ...
, which narrows the
trachea The trachea, also known as the windpipe, is a cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all air- breathing animals with lungs. The trachea extends from t ...
. This can result in reduced airflow to the lungs. Infants may be
intubated Intubation (sometimes entubation) is a medical procedure involving the insertion of a tube into the body. Patients are generally anesthetized beforehand. Examples include tracheal intubation, and the balloon tamponade with a Sengstaken-Blak ...
to make sure that the trachea is fixed open.


Limitations

Problems of gastrointestinal ''function'' are usually not well diagnosed by endoscopy since ''motion'' or ''secretion'' of the gastrointestinal tract is not easily inspected by EGD. Nonetheless, findings such as excess fluid or poor motion of the gut during endoscopy can be suggestive of disorders of function. Irritable bowel syndrome and functional dyspepsia are not diagnosed with EGD, but EGD may be helpful in excluding other diseases that mimic these common disorders.


Procedure

The tip of the endoscope should be lubricated and checked for critical functions including tip angulations, air and water suction, and image quality. The patient is kept NPO (nil per os) or NBM (nothing by mouth) for at least 4 hours before the procedure. Most patients tolerate the procedure with only
topical anesthesia A topical anesthetic is a local anesthetic that is used to numb the surface of a body part. They can be used to numb any area of the skin as well as the front of the eyeball, the inside of the nose, ear or throat, the anus and the genital area. To ...
of the oropharynx using lidocaine spray. However, some patients may need sedation and the very anxious/agitated patient may even need a general anesthetic.
Informed consent Informed consent is a principle in medical ethics and medical law, that a patient must have sufficient information and understanding before making decisions about their medical care. Pertinent information may include risks and benefits of treat ...
is obtained before the procedure. The main risks are bleeding and perforation. The risk is increased when a biopsy or other intervention is performed. The patient lies on their left side with the head resting comfortably on a pillow. A mouth-guard is placed between the teeth to prevent the patient from biting on the endoscope. The endoscope is then passed over the tongue and into the oropharynx. This is the most uncomfortable stage for the patient. Quick and gentle manipulation under vision guides the endoscope into the esophagus. The endoscope is gradually advanced down the esophagus making note of any pathology. Excessive insufflation of the stomach is avoided at this stage. The endoscope is quickly passed through the stomach and through the pylorus to examine the first and second parts of the duodenum. Once this has been completed, the endoscope is withdrawn into the stomach and a more thorough examination is performed including a J-maneuver. This involves retroflexing the tip of the scope so it resembles a 'J' shape in order to examine the fundus and gastroesophageal junction. Any additional procedures are performed at this stage. The air in the stomach is aspirated before removing the endoscope. Still
photograph A photograph (also known as a photo, image, or picture) is an image created by light falling on a photosensitive surface, usually photographic film or an electronic image sensor, such as a CCD or a CMOS chip. Most photographs are now create ...
s can be made during the procedure and later shown to the patient to help explain any findings. In its most basic use, the endoscope is used to inspect the internal anatomy of the digestive tract. Often inspection alone is sufficient, but
biopsy A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a dise ...
is a valuable adjunct to endoscopy. Small biopsies can be made with a pincer (biopsy forceps) which is passed through the scope and allows sampling of 1 to 3 mm pieces of tissue under direct vision. The intestinal mucosa heals quickly from such biopsies.


Equipment

* Endoscope ** Non-coaxial
optic fiber An optical fiber, or optical fibre in Commonwealth English, is a flexible, transparent fiber made by drawing glass ( silica) or plastic to a diameter slightly thicker than that of a human hair. Optical fibers are used most often as a me ...
system to carry light to the tip of the endoscope ** A chip camera at the tip of the endoscope – this has now replaced the coaxial optic fibers of older scopes that were prone to damage and consequent loss of picture quality ** Air/water channel to clean the lens using the water and air channel for drying the lens itself and to insufflate the esophagus and the stomach during the operation to prevent from collapsing the track to better vision in the procedure ** Suction/Working channels – these may be in the form of one or more channels ** Control handle – this houses the controls ** Umbilical Cords that connect to the light source and video processor to supply the endoscope with suction and air pressure and water for (suction and irrigation process) and light to transmit in the body to deliver the video signal to the processor to show the live image on the monitor * Stack ** Light source ** Suction ** Electrosurgical unit ** Video recorder/photo printer * Instruments ** Biopsy forceps ** Snares ** Injecting needles * Chemical agents ** Dimethicone ** Acetate ** Indigo carmine Image:Duodenal adenocarcinoma.png, Endoscopic image of adenocarcinoma of duodenum seen in the post-bulbar duodenum. Image:Gastric_antral_vascular_ectasia_(before_and_after).png, Endoscopic image of
gastric antral vascular ectasia Gastric antral vascular ectasia (GAVE) is an uncommon cause of chronic gastrointestinal bleeding or iron deficiency anemia. The condition is associated with dilated small blood vessels in the pyloric antrum, which is a distal part of the stomach. ...
seen as a radial pattern around the pylorus before (top) and after (bottom) treatment with argon plasma coagulation Image:Barretts esophagus.jpg, Endoscopic image of
Barrett's esophagus Barrett's esophagus is a condition in which there is an abnormal ( metaplastic) change in the mucosal cells lining the lower portion of the esophagus, from stratified squamous epithelium to simple columnar epithelium with interspersed goblet cells ...
, which is the area of red mucosa projecting like a tongue. Image:Deep gastric ulcer.png , Deep gastric ulcer Image:celiac 3.jpg, Endoscopic still of duodenum of patient with celiac disease showing scalloping of folds. Image:MALT 4.jpg, Gastric ulcer in antrum of stomach with overlying clot due to
gastric lymphoma Primary gastric lymphoma (lymphoma that originates in the stomach itself) is an uncommon condition, accounting for less than 15% of gastric malignancies and about 2% of all lymphomas. However, the stomach is a very common extranodal site for lymp ...
. Image:DU 2.jpg , Endoscopic image of a posterior wall duodenal ulcer with a clean base, which is a common cause of upper GI hemorrhage. Early stomach cancer 2a.jpg, Endoscopic images of an early stage stomach cancer. 0-IIa, tub1. Left column: Normal light. Right column: computed image enhanced ( FICE). First row: Normal. Second row: Acetate stained. Third row: Acetate-indigocarmine mixture ( AIM) stained.


See also

* Colonoscopy * Transnasal esophagoscopy


References

{{Authority control Endoscopy Diagnostic gastroenterology